Intracranial Regulation and Cognition

What are the therapeutic uses of Amitriptyline?

Depression, depressive episodes of bipolar disorders.

What additional contraceptive method should be used with phenytoin?

Use an additional method

What are the medications for depressive disorders - Serotonin norepinephrine reuptake inhibitors?

Venlafaxine

What are the nursing considerations and patient teaching for Phenobarbital?

Watch for signs of toxicity (ataxia, resp. depression, coma, pinpoint pupils, hypotension), avoid activities that require alertness (driving)

What are the therapeutic uses of Phenelzine?

Depression, bulimia, panic disorder, social anxiety disorder, GAD, OCD, PTSD.

What is the therapeutic level for phenytoin?

10 to 20 mcg/mL

What is donepezil?

A cholinesterase inhibitor used in the treatment of chronic neurologic disorders.

What is neostigmine?

A cholinesterase inhibitor used in the treatment of chronic neurologic disorders.

What is levodopa/carbidopa?

A combination medication used as an anti-Parkinson's medication.

What is neuroleptic malignant syndrome (NMS)?

A life-threatening condition.

What is Steven-Johnson syndrome?

A life-threatening skin disorder

What is venlafaxine?

A serotonin norepinephrine reuptake inhibitor used in the treatment of depressive disorders.

What is amitriptyline?

A tricyclic antidepressant medication.

What are the other answer choices for the instruction the nurse should include when teaching a client with a new prescription for levodopa/carbidopa for Parkinson's disease?

A. Increase intake of protein-rich foods. B. Expect muscle twitching to occur. D. Anticipate relief of manifestations in 24 hr.

What is carbamazepine?

An antiepileptic medication.

What is phenobarbital?

An antiepileptic medication.

What is phenytoin?

An antiepileptic medication.

What is topiramate?

An antiepileptic medication.

What is trazodone?

An atypical antidepressant medication.

What are the medications for chronic neurologic disorders?

Anti-Parkinson's medications, antiepileptics (AEDs).

What are the side effects/adverse reactions of oxybutynin?

Anticholinergic effects, hallucinations, confusion, insomnia, prolonged QT interval, tachycardia.

What are the side effects/adverse reactions of haloperidol?

Anticholinergic, sedation, headache, seizures, agranulocytosis, dysrhythmias, EPS, NMS

What are other atypical antidepressants?

Antidepressant medications that do not fit into the traditional categories.

What are tricyclic antidepressants?

Antidepressant medications that have a three-ring structure.

What are serotonin norepinephrine reuptake inhibitors?

Antidepressant medications that increase the levels of serotonin and norepinephrine in the brain.

What are monoamine oxidase inhibitors?

Antidepressant medications that inhibit the enzyme monoamine oxidase.

What are the nursing considerations and patient teaching for cyclobenzaprine?

Avoid driving, avoid alcohol and other CNS depressants.

What are the other answer choices for the medication the nurse should expect a prescription for when caring for a client with muscle weakness after receiving a nondepolarizing neuromuscular blocking agent?

B. Naloxone C. Dantrolene D. Vecuronium.

What is the expected pharmacological action of haloperidol?

Block dopamine, acetylcholine, histamine, and norepinephrine receptors in the brain and periphery, inhibition of psychotic manifestations

What is the expected pharmacological action of Venlafaxine?

Block reuptake of norepinephrine as well as serotonin with effects similar to the SSRIs

What is the expected pharmacological action of risperidone?

Block serotonin and dopamine receptors

What are the symptoms of Parkinsonism?

Bradykinesia, rigidity, shuffling gait, tremors, drooling.

What are the side effects/adverse reactions of cyclobenzaprine?

CNS depression (confusion, fainting, fatigue, sleepiness), physical dependence with long-term use.

What are the side effects/adverse reactions of Phenobarbital?

CNS effects (drowsiness, sedation, depression), physical dependence

What is Parkinson's disease?

Chronic, progressive neurodegenerative disorder.

What are the symptoms of akathisia?

Constant motion, restlessness, feet moving back and forth.

What are the nursing considerations and patient teaching for neuromuscular blocking agents?

Continuous resp and cardio monitoring, have resuscitation equipment available, administer neostigmine to reverse the action as needed, monitor potassium levels, carefully monitor for return of resp function after discontinuing.

What is the expected pharmacological action of Phenobarbital?

Control seizure disorders, enhances inhibitory effects of GABA to decrease seizure activity

What is the expected pharmacological action of phenytoin?

Control seizure disorders, slows sodium entrance into neurons, extends time for nerve to return to active state, slows neuron firing frequency.

What are the therapeutic uses of Trazodone?

Depression, Usually used with another antidepressant agent, insomnia.

What are the other medications in the same category as cholinesterase inhibitors?

Donepezil.

What are the nursing considerations and patient teaching for oxybutynin?

Drink lots of fluids, monitor ECG, swallow ER tablets whole, contraindicated in patients with glaucoma, myasthenia gravis, GI or GU obstruction.

What is the pharmacological action of topiramate?

Enhances inhibitory effects of GABA to decrease seizure activity

What are the side effects/adverse reactions of cholinesterase inhibitors?

Excessive muscarinic stimulation, cholinergic crisis, paralysis of respiratory muscles.

What are the side effects/adverse reactions of phenytoin?

Gingival hyperplasia, nystagmus, diplopia, headache, dizziness, slurred speech, drowsiness, confusion, constipation, dysrhythmias, hypotension, depression, suicidal ideation, rash.

What are the symptoms of Sludge and the Killer Bs?

Increased GI motility, secretions, diaphoresis, salivation, bradycardia.

What are the side effects/adverse reactions of extreme muscarinic stimulation?

Increased gastric acid secretion, abdominal cramps, diarrhea, sweating, urinary urgency, bradycardia, hypotension, bronchoconstriction causing asthma exacerbation, dysrhythmias in clients with hyperthyroidism.

What is the expected pharmacological action of oxybutynin?

Inhibit muscarinic receptors of the detrusor muscle of the bladder, which prevents contractions of the bladder and the urge to void.

What is the review of depression?

Insufficient amount of monoamine neurotransmitters (dopamine, serotonin, norepinephrine), Reactive Depression (sudden onset after a precipitating event), Major Depression (loss of interest, difficulty concentrating, fatigue, worthlessness), Bipolar Affective Disorder (swings between manic and depressive episodes)

What are the symptoms of acute dystonia?

Involuntary movement and abnormal muscle tone/postures, eyes rolling upwards, severe spasms/contractions of the neck, face, or back. If laryngeal muscles are affected, respiration can decrease (crisis requiring rapid treatment).

What are extrapyramidal effects (EPS)?

Involuntary movement and abnormal muscle tone/postures.

What is the expected pharmacological action of Succinylcholine?

It fills the cholinergic receptors, preventing ACh from binding with them.

What is the teratogenic risk associated with carbamazepine?

It is associated with birth defects

What is the teratogenic risk associated with topiramate?

It is teratogenic

What is the medication Succinylcholine used for?

It mimics ACh by binding with cholinergic receptors at the neuromuscular junction, causing sustained depolarization of the muscle and resulting in muscle paralysis. It has a short duration of action.

What are the symptoms of tardive dyskinesia?

Lip smacking, sucking, chewing, involuntary movements of the tongue.

What are some nursing considerations for phenytoin administration?

Maintain good oral hygiene, administer at slow IV rate to prevent cardiovascular effects, stop tube feedings 1-2 hours before administration

What are the therapeutic uses of Venlafaxine?

Major depression, GAD, social anxiety disorder, panic disorder, pain associated with fibromyalgia, osteoarthritis, and diabetic neuropathy

What are the nursing considerations and patient teachings for patients taking Amitriptyline?

May take 10-14 days or longer to work, monitor for suicidal tendencies, change positions slowly, avoid driving if sedation is excessive, use w/ caution in pregnancy and breastfeeding.

What is the medication and expected pharmacological action of Amitriptyline?

Medication: Amitriptyline, Expected Pharmacological Action: Blocks reuptake of norepinephrine and serotonin in the synaptic space, intensifying the effects of these neurotransmitters.

What is the medication and expected pharmacological action of Phenelzine?

Medication: Phenelzine, Expected Pharmacological Action: Block MAOI enzymes in the brain, increasing norepinephrine, dopamine, serotonin, and tyramine available for transmission of impulses.

What is the medication and expected pharmacological action of Trazodone?

Medication: Trazodone, Expected Pharmacological Action: Moderate selective blockade of serotonin receptors, which allows more serotonin to be available for impulse transmission.

What are cholinesterase inhibitors?

Medications that inhibit the breakdown of acetylcholine.

What are anti-Parkinson's medications?

Medications used to treat Parkinson's disease.

What are antiepileptics (AED's)?

Medications used to treat epilepsy.

What are depressive disorders?

Mental health disorders characterized by persistent feelings of sadness and loss of interest.

What are the nursing considerations and patient teaching for haloperidol?

Monitor for NMS symptoms, hold medication and notify provider, monitor for infection, obtain CBC and ECG, administer IM with large gauge needle, assess behavior, avoid alcohol

What are the nursing considerations and patient teachings for patients taking Trazodone?

Monitor for serotonin syndrome, monitor for suicidal tendencies, avoid grapefruit, therapeutic effects may take a few weeks.

What nursing considerations should be taken for topiramate?

Monitor mental health, limit strenuous activity, monitor blood bicarb levels, watch for manifestations of glaucoma and have periodic eye exams

What are the nursing considerations and patient teachings for patients taking medications for depressive disorders?

Monitor weight, vitals, avoid driving and use of machinery, assess patients carefully for suicidal ideation.

What are the therapeutic uses of cyclobenzaprine?

Muscle relief of muscle spasm related to muscle injury.

What are the therapeutic uses of cholinesterase inhibitors?

Myasthenia gravis, reversal of nondepolarizing neuromuscular blocking agents.

What are the side effects/adverse reactions of risperidone?

N/A

What are the side effects/adverse reactions of Venlafaxine?

Nausea, weight loss, headache, anxiety, hypertension, tachy, Neuroleptic malignant syndrome, suicidal thoughts, dizziness, mydriasis, serotonin syndrome, sexual dysfunction

What medication should the nurse expect a prescription for when caring for a client with muscle weakness after receiving a nondepolarizing neuromuscular blocking agent?

Neostigmine.

What are the medications for the central nervous system?

Neuromuscular blocking agents, muscle relaxants, muscarinic agonist, muscarinic antagonist.

What are the therapeutic uses of bethanechol?

Nonobstructive urinary retention, usually postoperatively or postpartum, investigational basis to treat gastroesophageal reflux.

What are some side effects/adverse reactions of carbamazepine?

Nystagmus, diplopia, staggering gait, headache, blood dyscrasias, skin disorders (rash, dermatitis, photosensitivity, Steven Johnson Syndrome), nausea

What are the side effects/adverse reactions of Amitriptyline?

OH, anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation, tachy), sedation.

What nursing considerations should be taken for carbamazepine?

Obtain initial CBC, monitor CBC, monitor for bruising/bleeding, treat mild skin side effects with antihistamines, avoid grapefruit, administer with food

What is the therapeutic use of oxybutynin?

Overactive bladder.

What is gingival hyperplasia?

Overgrowth of gum tissue

What is the medication for chronic neurologic disorders?

Phenobarbital

What is the expected pharmacological action of cholinesterase inhibitors?

Prevent cholinesterase from inactivating acetylcholine, increasing Ach availability.

What are the therapeutic uses of neuromuscular blocking agents?

Promote muscle relaxation during general anesthesia, control spontaneous resp. movements in clients with mechanical ventilation, used during endotracheal intubation and endoscopy.

What are the nursing considerations and patient teaching for cholinesterase inhibitors?

Provide respiratory support, have resuscitation equipment available, administer via various routes.

What are the side effects/adverse reactions of neuromuscular blocking agents?

Respiratory arrest, prolonged apnea, malignant hyperthermia, muscle pain, hyperkalemia.

What are the therapeutic uses of haloperidol?

Schizophrenia, Tourette's, bipolar disorder (manic), chronic psychosis

What are the side effects/adverse reactions of Trazodone?

Sedation, priapism, suicidal thoughts in children & adolescents (black box warning).

What are the therapeutic uses of Phenobarbital?

Seizure disorders

What are the therapeutic uses of topiramate?

Seizure disorders, bipolar disorder

What are the therapeutic uses of carbamazepine?

Seizure disorders, bipolar disorder, trigeminal and glossopharyngeal neuralgias

What are the therapeutic uses of phenytoin?

Seizure disorders.

What are the medications for depressive disorders?

Serotonin norepinephrine reuptake inhibitors, Venlafaxine, Other atypical antidepressants, Trazadone, Tricyclic antidepressants, Amitriptyline, Monoamine oxidase inhibitors, Phenelzine

What are the symptoms of Parkinson's disease?

Slowness in initiation of movement, increased muscle tone, tremor at rest, gait disturbance, masked face/flat affect.

What is the pharmacological action of carbamazepine?

Slows the entrance of sodium or calcium back into the neuron, extending the time it takes for the nerve to return to its active state and slows the frequency of neuron firing

What is the expected pharmacological action of bethanechol?

Stimulation of muscarinic receptors of the GU tract, causing relaxation of the trigone and sphincter muscles and contraction of the detrusor muscle to increase bladder pressure and excretion of urine.

What are some side effects/adverse reactions of topiramate?

Suicidal ideation, dizziness, diplopia, confusion, weight loss, nausea, reduced sweating with increased body temperature, metabolic acidosis, angle-closer glaucoma

What are the nursing considerations and patient teaching for muscarinic antagonist medications?

Take on an empty stomach, monitor vitals, contraindicated in patients with asthma, hyperthyroidism, peptic ulcer disease, urinary or GI obstruction.

What instruction should the nurse include when teaching a client with a new prescription for levodopa/carbidopa for Parkinson's disease?

Take this medication with food.

What is the mechanism of action of cholinesterase inhibitors?

They prevent the breakdown of acetylcholine, increasing its availability in the brain.

How can tube feedings interfere with phenytoin absorption?

They should be stopped 1-2 hours before administration